Gastrointestinal nematodes: the Karkar experience

This paper reviews our research on the hookworm Necator americanus over several years. Our field site for the research was on Karkar Island, Papua New Guinea, where we found a prevalence of N. americanus infection among adults of nearly 100%. The intensity of infection was related to host age and to the development of iron deficiency anaemia, which occurred at a much lower infection intensity than had been previously reported. We studied the immune response to infection and our results initially suggested that antibody responses and eosinophilia do not protect the host against infection. However, we have more recently found a negative correlation of both IgE and eosinophilia with the weight and fecundity of N. americanus which suggests that the immune response does have some effect on N. americanus and that this immunity is dependent on the Th2 subset of T lymphocytes. Following treatment for hookworm, the prevalence of N. americanus returned almost to pretreatment levels within 2 years, with the rate of acquisition of adult worms independent of host age. A significant predisposition to hookworm infection was demonstrated by individuals. Prevention will result from measures to reduce the transmission and intensity of infection, and can be achieved through improved sanitation or by vaccination. However, vaccination is not yet a viable option because of our limited knowledge about protective immunity.